Sirico Giusy, Spadera Lucrezia, De Laurentis Mario, Brevetti Gregorio
Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples "Federico II".
Monaldi Arch Chest Dis. 2009 Mar;72(1):10-7. doi: 10.4081/monaldi.2009.337.
Although during the last decade there have been great advances in our knowledge of the epidemiology and pathophysiology of multi-district atherosclerotic disease, little is known about the association between peripheral arterial disease and carotid artery disease. This review was conceived to cast some light on this topic, paying special attention to inflammation which plays a pivotal role in atherosclerosis. An aspect of pathophysiologic and clinical relevance is that the coexistence of carotid disease is more frequent in peripheral arterial disease than in coronary artery disease, not only in terms of carotid stenosis, but also with respect to the presence of hypoechoic unstable plaque. These latter plaques present a large infiltration of macrophages and are associated to high levels of inflammatory markers. In particular, the greater prevalence of hypoechoic carotid plaques in peripheral arterial disease compared to patients with carotid artery disease was poorly related to classic risk factors, but showed an independent association with an increased number of leukocyte and neutrophil cells, which are reliable markers of inflammation. The greater prevalence of hypoechoic unstable carotid plaques could explain why peripheral arterial disease portends higher risk of stroke than coronary artery disease.
尽管在过去十年间，我们对多部位动脉粥样硬化疾病的流行病学和病理生理学的认识取得了巨大进展，但对于外周动脉疾病与颈动脉疾病之间的关联却知之甚少。本综述旨在阐明这一主题，特别关注在动脉粥样硬化中起关键作用的炎症。病理生理学和临床相关性的一个方面是，外周动脉疾病中颈动脉疾病的共存情况比冠状动脉疾病更为常见，这不仅体现在颈动脉狭窄方面，还涉及低回声不稳定斑块的存在。这些斑块有大量巨噬细胞浸润，并与高水平的炎症标志物相关。特别是，与颈动脉疾病患者相比，外周动脉疾病中低回声颈动脉斑块的患病率更高，这与经典危险因素关系不大，但与白细胞和中性粒细胞数量增加存在独立关联，而这些细胞是炎症的可靠标志物。低回声不稳定颈动脉斑块的患病率更高，可以解释为什么外周动脉疾病比冠状动脉疾病预示着更高的中风风险。
